A few critical stories have been lost in the firestorm over the birth control rule the Obama administration is implementing as part of the Affordable Care Act. For example, the fact that
all employers have had to provide contraceptive coverage in their plans since 2000, though the coverage didn't have to be at no cost to the employee.
The fact that 28 states already have a policy requiring contraceptive coverage, with 20 of them providing an exemption for religious institutions, has received some attention, as has the fact that the nation's largest Catholic university, DePaul, provides contraceptive coverage to its employees.
What's new in all of this is that contraceptives, classified as preventive care under the Affordable Care Act, will be provided at no cost to subscribers—but not all subscribers. What hasn't been made clear in the news coverage of this, or in recent White House statements, is that the new policy will not be in effect for everyone. That's a pretty critical omission, and many women might be unpleasantly surprised at the pharmacy counter when they have to pony up a co-pay for their birth control.
This new rule, like most of the ACA's provisions, will apply only to new policies that go into effect once the rule is established. A number of provisions will affect all insurance contracts, existing and new. They include: prohibiting insurers from applying lifetime benefit caps to key health services; prohibiting insurers from canceling insurance because of simple mistakes made by the subscriber or employer at enrollment; and extension of coverage to adult children of enrollees.
So for what's not covered in existing, or grandfathered plans, specifically as it relates to this rule: "certain recommended preventive services at no additional charge to you."
Free contraceptives falls under preventive services, and they are not required to be provided in either existing individual or employer-based plans. A Health and Human Services official verified and explained that "plans that were in place before the law was passed almost two years ago are grandfathered." However, "As those plans change, they lose their grandfathered status. So, over time, fewer and fewer plans are grandfathered." Which means as the grandfathered plans change significantly enough to lose that status, the new free preventive health services, including contraception, will be incorporated into them. They lose their "grandfathered" status if "they choose to significantly cut benefits or increase out-of-pocket spending for consumers—and consumers in plans that make such changes will gain new consumer protections."
While HHS couldn't provide specifics as to how many women will not receive the benefit of free contraception, it's most women who have been insured by the same policy since March 23, 2010, when the ACA went into effect.